Time | Patient status/Event |
---|---|
0715 – 0800 Pre-Hospital | Patient was unresponsive with absent pedal pulses but palpable radial pulses with delayed capillary refill. A 20 ga. IV line was established and patient was intubated. Vitals were bradycardia with HR 33/minute, BP of 86/51 mm Hg, and tympanic temperature of 25.5°C. Warm IV fluids were given and hot packs were applied to groins and axillae. |
0800 Arrival to Hospital | Patient arrived to medical center with no palpable pulses. Monitor showed PEA with bradycardia of HR 31/minute. CPR was started. Atropine 0.5 mg IV was administered followed by 1 mg epinephrine IV. Tympanic temperature was 25.5°C. |
0808 | Patient converted to sinus rhythm with HR 66/minute, but shortly thereafter went into pulseless V-tach. An amiodarone bolus of 300 mg was administered IV followed by 1 gm calcium IV. The patient went into V-fib and CPR resumed. |
0812 | Central line placed along with an additional 16 ga. IV line. Warm IV fluids were administered. |
0815 – 0825 | A gastric tube and bilateral chest tubes were placed. Warm gastric and pleural irrigation was initiated. |
0845 | Patient remained in V-fib arrest receiving CPR. Temperature remained 25.6°C despite conventional warming therapies of warm fluid instillation (IV, gastric, intrapleural), warm humidified oxygen, and warming blankets. The decision was made for extracorporeal rewarming and resuscitation. |
0845 – 0900 | Patient was heparinized, CPS unit was assembled and primed, and arterial and venous cannulas were placed for fem-fem CPS. |
0900 | Patient was placed on fem-fem CPS and CPR was stopped. Patient remained in V-fib arrest. CPS unit temperature monitoring confirmed patient blood temperature of 25.5°C. |
0900 – 1100 | Patient was slowly rewarmed on CPS and electrolytes and acid base status were normalized. Patient remained in V-fib arrest. An arterial line was placed which showed a systolic BP of 55 mm Hg. Vasopressin was started. |
1102 | Patient temperature was 34.9°C and defibrillation was attempted. Initial defibrillation at 200 J converted rhythm from V-fib to V-tach, and a subsequent defibrillation of 300 J converted rhythm to SVT. A bolus of 300 mg amiodarone IV was administered followed by 1 gm calcium chloride IV. |
1112 | Patient reverted into V-tach. Two defibrillation attempts of 360 J converted rhythm into sinus tachycardia and HR 102/minute. Patient temperature was 35.5°C. |
1200 | Patient temperature was 37°C after 180 minutes of extracorporeal rewarming. |
1230 | Patient was transported to OR for weaning of CPS and decannulation under direct vision. Patient was in sinus rhythm, HR 87/minute. |
1330 | Patient was successfully weaned from CPS after 270 minutes of bypass with BP 140/60, HR 80/minute, in sinus rhythm, and temperature of 37°C. |